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Introduction: The oral case presentation is recognized as a core educational and patient care activity but has not been well studied in the emergency setting. The objectives of this study are: 1) to develop a competency-based assessment tool to formally evaluate the emergency medicine oral case presentation (EM-OCP) competency of medical students and ‘transition to discipline’ residents, and 2) to develop, implement and evaluate a curriculum to enhance oral case presentation (OCP) communication skills in the emergency medicine (EM) setting. Methods: Using data from a literature review, a Canadian Association of Emergency Physicians national survey, and local focus groups, the authors designed an OCP framework, blended learning curriculum, and EM-OCP assessment tool. Ninety-six clerkship students were randomly assigned to receive either the control, the standard clerkship curriculum, or intervention, the blended learning curriculum. At the beginning of their emergency medicine rotation, learners completed a pre-test using a standardized patient (SP) case to assess their baseline OCP skills. The intervention group then completed the EM-OCP curriculum. All students completed post-tests with a different SP at the end of the six-week EM rotation. Audio-recordings of pre and post-tests were evaluated using the assessment tool by two blinded evaluators. Results: Using the Kruskal-Wallis test, all students demonstrated improvement in EM-OCP skills between their pre-test and post-test, however, those who received the blended learning curriculum showed significantly greater improvement in synthesis of information (p = 0.044), management (p = 0.006) and overall entrustment decision score (p = 0.000). Conclusion: Implementation of a novel EM-OCP curriculum resulted in more effective communication and higher entrustment scores. This curriculum could improve OCP performance not only in emergency medicine settings but also across specialties where medical students and residents must manage critical patients.
Introduction: Time-to-treatment plays a pivotal role in survival from sudden cardiac arrest (SCA). Every minute delay in defibrillation results in a 7-10% reduction in survival. This is particularly problematic in rural and remote regions, where bystander and EMS response is often prolonged and automated external defibrillators (AED) are often not available. Our objective was to examine the feasibility of a novel AED drone delivery method for rural and remote SCA. A secondary objective was to compare times between AED drone delivery and ambulance response to various mock SCA resuscitations. Methods: We conducted 6 simulations in two different rural communities in southern Ontario. During phase 1 (4 simulations) a “mock” call was placed to 911 and a single AED drone and an ambulance were simultaneously dispatched from the same location to a pre-determined destination. Once on scene, trained first responders retrieved the AED from the drone and initiated resuscitative efforts on a manikin. The second phase (2 scenarios) were done in a similar manner save for the drone being dispatched from a regionally optimized location for drone response. Results: Phase 1: The distance from dispatch location to scene varied from 6.6 km to 8.8 km. Mean (SD) response time from 911 call to scene arrival was 11.2 (+/- 1.0) minutes for EMS compared to 8.1 (+/- 0.1) for AED drone delivery. In all four simulations, the AED drone arrived before EMS, ranging from 2.1 to 4.4 minutes faster. The mean time for trained responders to retrieve the AED and apply it to the manikin was 35 (+/- 5) sec. No difficulties were encountered in drone activation by dispatch, drone lift off, landing or removal of the AED from the drone by responders. Phase 2: The ambulance response distance was 20km compared to 9km for the drone. Drones were faster to arrival at the scene by 7 minutes and 8 minutes with AED application 6 and 7 minutes prior to ambulance respectively. Conclusion: This implementation study suggests AED drone delivery is feasible with improvements in response time during a simulated SCA scenario. These results suggest the potential for AED drone delivery to decrease time to first defibrillation in rural and remote communities. Further research is required to determine the appropriate distance for drone delivery of an AED in an integrated EMS system as well as optimal strategies to simplify bystander application of a drone delivered AED.
To describe the infection control preparedness measures undertaken for coronavirus disease (COVID-19) due to SARS-CoV-2 (previously known as 2019 novel coronavirus) in the first 42 days after announcement of a cluster of pneumonia in China, on December 31, 2019 (day 1) in Hong Kong.
A bundled approach of active and enhanced laboratory surveillance, early airborne infection isolation, rapid molecular diagnostic testing, and contact tracing for healthcare workers (HCWs) with unprotected exposure in the hospitals was implemented. Epidemiological characteristics of confirmed cases, environmental samples, and air samples were collected and analyzed.
From day 1 to day 42, 42 of 1,275 patients (3.3%) fulfilling active (n = 29) and enhanced laboratory surveillance (n = 13) were confirmed to have the SARS-CoV-2 infection. The number of locally acquired case significantly increased from 1 of 13 confirmed cases (7.7%, day 22 to day 32) to 27 of 29 confirmed cases (93.1%, day 33 to day 42; P < .001). Among them, 28 patients (66.6%) came from 8 family clusters. Of 413 HCWs caring for these confirmed cases, 11 (2.7%) had unprotected exposure requiring quarantine for 14 days. None of these was infected, and nosocomial transmission of SARS-CoV-2 was not observed. Environmental surveillance was performed in the room of a patient with viral load of 3.3 × 106 copies/mL (pooled nasopharyngeal and throat swabs) and 5.9 × 106 copies/mL (saliva), respectively. SARS-CoV-2 was identified in 1 of 13 environmental samples (7.7%) but not in 8 air samples collected at a distance of 10 cm from the patient’s chin with or without wearing a surgical mask.
Appropriate hospital infection control measures was able to prevent nosocomial transmission of SARS-CoV-2.
This study aimed to highlight the key studies that have led to the current understanding and treatment of head and neck cancer.
The Thomson Reuters Web of Science database was used to identify relevant manuscripts. The results were ranked according to the number of citations. The 100 most cited papers were analysed.
A total of 63 538 eligible papers were returned. The median number of citations was 626. The most cited paper compared radiotherapy with and without cetuximab (3205 citations). The New England Journal of Medicine had the most citations (23 514), and the USA had the greatest number of publications (n = 66). The most common topics of publication were the treatment (n = 45) and basic science (n = 19) of head and neck cancer, followed by the role of human papillomavirus (n = 16).
This analysis highlighted key articles that influenced head and neck cancer research and treatment. It serves as a guide as to what makes a ‘citable’ paper in this field.
Abnormal effort-based decision-making represents a potential mechanism underlying motivational deficits (amotivation) in psychotic disorders. Previous research identified effort allocation impairment in chronic schizophrenia and focused mostly on physical effort modality. No study has investigated cognitive effort allocation in first-episode psychosis (FEP).
Cognitive effort allocation was examined in 40 FEP patients and 44 demographically-matched healthy controls, using Cognitive Effort-Discounting (COGED) paradigm which quantified participants’ willingness to expend cognitive effort in terms of explicit, continuous discounting of monetary rewards based on parametrically-varied cognitive demands (levels N of N-back task). Relationship between reward-discounting and amotivation was investigated. Group differences in reward-magnitude and effort-cost sensitivity, and differential associations of these sensitivity indices with amotivation were explored.
Patients displayed significantly greater reward-discounting than controls. In particular, such discounting was most pronounced in patients with high levels of amotivation even when N-back performance and reward base amount were taken into consideration. Moreover, patients exhibited reduced reward-benefit sensitivity and effort-cost sensitivity relative to controls, and that decreased sensitivity to reward-benefit but not effort-cost was correlated with diminished motivation. Reward-discounting and sensitivity indices were generally unrelated to other symptom dimensions, antipsychotic dose and cognitive deficits.
This study provides the first evidence of cognitive effort-based decision-making impairment in FEP, and indicates that decreased effort expenditure is associated with amotivation. Our findings further suggest that abnormal effort allocation and amotivation might primarily be related to blunted reward valuation. Prospective research is required to clarify the utility of effort-based measures in predicting amotivation and functional outcome in FEP.
Agents that block the renin–angiotensin system (RAS) improve glucoregulation in the metabolic syndrome disorder. We evaluated the effects of egg white hydrolysate (EWH), previously shown to modulate the protein abundance of RAS component in vivo, on glucose homeostasis in diet-induced insulin-resistant rats. Sprague–Dawley rats were fed a high-fat diet (HFD) for 6 weeks to induce insulin resistance. They were then randomly divided into four groups receiving HFD or HFD supplemented with different concentrations of EWH (1, 2 and 4 %) for another 6 weeks in the first trial. In the second trial, insulin-resistant rats were divided into two groups receiving only HFD or HFD+4 % EWH for 6 weeks. Glucose homeostasis was assessed by oral glucose tolerance and insulin tolerance tests. Insulin signalling and protein abundance of RAS components, gluconeogenesis enzymes and PPARγ were evaluated in muscle, fat and liver. Adipocyte morphology and inflammatory markers were evaluated. In vivo administration of EWH increased insulin sensitivity, improved oral glucose tolerance (P < 0·0001) and reduced systemic inflammation (P < 0·05). EWH potentiated insulin-induced Akt phosphorylation in muscle (P = 0·0341) and adipose tissue (P = 0·0276), but minimal differences in the protein abundance of tissue RAS components between the EWH and control groups were observed. EWH treatment also reduced adipocyte size (P = 0·0383) and increased PPARγ2 protein abundance (P = 0·0237). EWH treatment yielded positive effects on the inflammatory profile, glucose tolerance, insulin sensitivity and adipocyte differentiation in HFD-induced insulin resistance rats. The involvement of local RAS activity requires further investigation.
The humble pendulum is often invoked as the archetype of a simple, gravity driven, oscillator. Under ideal circumstances, the oscillation frequency of the pendulum is independent of its mass and swing amplitude. However, in most real-world situations, the dynamics of pendulums is not quite so simple, particularly with additional interactions between the pendulum and a surrounding fluid. Here we extend the realm of pendulum studies to include large amplitude oscillations of heavy and buoyant pendulums in a fluid. We performed experiments with massive and hollow cylindrical pendulums in water, and constructed a simple model that takes the buoyancy, added mass, fluid (nonlinear) drag and bearing friction into account. To first order, the model predicts the oscillation frequencies, peak decelerations and damping rate well. An interesting effect of the nonlinear drag captured well by the model is that, for heavy pendulums, the damping time shows a non-monotonic dependence on pendulum mass, reaching a minimum when the pendulum mass density is nearly twice that of the fluid. Small deviations from the model’s predictions are seen, particularly in the second and subsequent maxima of oscillations. Using time-resolved particle image velocimetry (TR-PIV), we reveal that these deviations likely arise due to the disturbed flow created by the pendulum at earlier times. The mean wake velocity obtained from PIV is used to model an extra drag term due to incoming wake flow. The revised model significantly improves the predictions for the second and subsequent oscillations.
Introduction: Online medical education resources are widely used in emergency medicine (EM), but strategies to assess quality remain elusive. We previously derived the Medical Education Translational Resources: Impact and Quality (METRIQ) 8 instrument to evaluate quality in medical education blog posts. Methods: As part of a subsequent validation study (The METRIQ Blog Study), a mixed-methods usability analysis was performed to obtain user feedback on the quality assessment instrument in order to improve its clarity and reliability. Participants in the METRIQ Study were first asked to rate five blog posts using the METRIQ-8 Score. They then evaluated the METRIQ-8 instruments ease of use and likelihood of being recommended to others using a 7-point Likert scale and free text comments. Participants were also asked to flag and comment on items within the score that they felt were unclear. Global usability ratings were summarized using median scores or percent rated unclear. We used ANOVA to test associations between ease of use and demographic factors. A thematic analysis was performed on the comments. Results: 309 EM medical students, residents, and attendings completed the survey. Global ratings were generally very favorable (median 2 [IQR 2-3], with 7 being the lowest score) for ease of use and likelihood of recommendation, and did not vary by participants country of origin, frequency of blog use, or learner level. Participants stated that the score was structured, systematic, and straightforward. They found it useful for junior learners and for guiding blog creation. Four questions in the score (questions 2, 4, 5, and 7) were identified by 10% of subjects to be unclear. Thematic analysis of comments identified suggested four main themes for improving the score: adding clearer definitions with marking rubrics; shortening the 7-point scale; adding items evaluating blog post presentation and utility; and, rephrasing the wording of certain questions for clarity. Conclusion: A mixed methods usability analysis of the METRIQ-8 instrument for assessing blog quality was globally well received by EM medical students, residents, and attendings. Qualitative analyses revealed multiple areas to improve the instruments clarity and usability. The METRIQ score is a promising instrument for evaluating the quality of blogs; further development and testing is needed to improve its utility.
Introduction: The GridlockED game is a serious game aimed at teaching junior learners about flow and organization in the emergency department(ED). With serious games, the mechanism of learning is thought to be via the gameplay experience. Objectives built into gameplay are aimed at teaching players about a specific concept; in this case, we hoped to teach players about interprofessional collaboration and basic mechanics that drive flow in the ED. However, before a player can be taught, he or she must be engaged and have a positive gameplay experience. From the GridlockED gameplay, we aim to explore how a players gameplay experience related to observed actions while playing the game, including participating in decision making and keeping the team organized. Methods: From April-August 2017, participants were invited to play 4 turns of a GridlockED game session. They were video recorded during gameplay. After playing the game, they were surveyed using the previously derived Game Experience Questionnaire (GEQ) to measure their gameplay experience. The videos were reviewed by two research team members (SH, EJ), tallying various observed game actions. We conducted Pearson correlation between players GEQ total score and their observed actions. Results: A total of 32 participants (13 attendings, 5 senior residents, 10 junior residents, and 4 nurses) played the game. The average total GEQ was 67.2/132 (SD=10.7), suggesting most players had a moderately good gameplay experience. The total GEQ score correlated with component subscores within the questionnaire. Overall observed activity correlated well with each observed action subtype. However, the GEQ total score did not correlate significantly with the total observed action (Pearsons r=0.18,p=0.32). GEQ total score was found to be moderately correlated to an observation that a player participated in determining strategy during gameplay (r=0.36,p=0.04). There was a moderate negative correlation between determining strategy during gameplay and teaching about the game (r=-0.37,p=0.04) or emergency medicine concepts (r=-0.47,p<0.01). Conclusion: The GEQ is internally consistent, but does not have a strong relationship to observed actions, suggesting that game experience does not necessarily correlate with observable actions. This suggests that players may be intellectually stimulated or engaged without necessarily completing any observable actions during gameplay.
Introduction: The management of patient flow in the emergency department (ED) is crucial for the practice of emergency medicine (EM). However, this skill is difficult to teach didactically and is learned implicitly in the latter half of residency training. To help expedite the learning process, we developed the GridlockED board game as an educational tool to simulate ED patient flow. By having junior medical trainees play this game, we believe that they will develop a greater understanding of patient flow and resource management in the ED. Additionally, since GridlockED is a cooperative game, players may also benefit by improving their communication and teamwork skills. Methods: GridlockED was developed over twenty months of iterative gameplay and review. Feedback from attending emergency physicians, residents, and medical students was integrated into the game through a Plan-Do-Study-Act (PDSA) model. Emergency medicine nurses, physicians and residents at McMaster University were recruited to play GridlockED. Each player completed a pre-survey to collect demographic data and to assess their prior experience with playing board games. All play sessions were recorded for data collection purposes. Following each game session, a member of the research team conducted an exit interview with the players to gather information about their play experience and the educational value of the game. A post-survey was also sent to each participant for further feedback. Results: Eighteen gameplay sessions were conducted from June to August 2017. A total of thirty-two participants played the game (13 emergency physicians, 15 residents, and four nurses). Overall responses to the post-gameplay survey showed that players endorsed GridlockED as a useful potential teaching tool (75%, n=24/32) and the majority felt that it had the potential to improve patient flow in the ED (56%, n=18/32). Most participants found that the game was easy to play (91%, n=27/29), and that the instructions were clear (87.5%, n=28/32). Respondents also felt that the game reflected real life scenarios (56%, n=18) and that cases reflected the types of patients that they saw in the ED (78%, n=25). Conclusion: Our results have shown an overall positive response to GridlockED, with most participants supporting it as both an engaging board game and potential teaching tool. We believe that future studies with larger sample sizes and medical students will further validate the use of serious games in medical education.
Introduction: Competency-based workplace assessments are important in clinical training. However, feedback and assessment are still often perceived as unsatisfactory, particularly in busy settings such as emergency departments. Currently, little is known about how attending staff physicians sense of self may interface with the processes they use to assess and give feedback to trainees. We aimed to understand how attendings perceive their roles when tasked with conducting assessments and providing feedback to trainees. Methods: We conducted semi-structured, individual interviews with attendings (n=16) who used McMAP (McMaster Modular Assessment Program), a workplace-based assessment system at McMaster Universitys Royal College Emergency Medicine program. Attendings were recruited using snowball sampling. Data were interpreted using thematic analysis, sensitized to the dramaturgical lens and rater cognition frameworks. Results: Attendings identified themselves using three distinct but intimately connected roles when assessing trainee performance: the doctor that ensures the safety and well-being of patients; the coach (educator) that empowers, guides, and supports the next generation of medical doctors; and the assessor that formally assesses a trainees progression through the residency program. These roles are influenced by clinical training and experience, teaching experience and context. Conclusion: The ways in which attendings assess and provide feedback to trainees involve a complex and dynamic process that is influenced by their perceived roles as a doctor, coach, and assessor. Understanding the way attendings view and juggle their roles may provide insight into potentially new approaches to assessment and feedback. Results and implications will be discussed.
Introduction: Emergency medicine (EM) is a demanding specialty with high rates of physician burnout. As emergency physicians, we must stay healthy to promote healthy living, optimize our ability to care for our patients, extend our careers, and be there for our families. While we all desire a healthy lifestyle, maintaining one in practice can be difficult. We sought to investigate the strategies emergency physician employ to maintain and improve health and wellness while mitigating the professions stressors. Methods: From April 2015 to July 2017, forty-three wellness champions from Canada, the USA, and Australia were identified using a snowball sampling technique. Each participant answered 5 introductory questions and 8 productivity questions pertaining to health and wellness. These were transcribed and loaded to a publicly accessible blog, ALiEM.com, as part of the Healthy in EM series. Two investigators reviewed the transcripts using inductive methods and a grounded theory approach to generate themes and subthemes using coding software, NVivo (Burlington, Massachusetts), until saturation was achieved. Consensus between investigators (JC, ZP) established the master code and audit trail. An external audit by investigators (TC, BT) not involved with the initial analysis was performed to ensure reliability. Results: Major themes including diet, sleep, exercise and social activities were coded and further subcategorized along with perspectives, habits, personal philosophies, and career diversity. These themes translated across both professional and personal aspects of participants lives. For example, the pre-shift and post-shift strategies often included some form of regimented activities-of-daily-living that required discipline to adhere to at work and home. Conclusion: Our findings show the importance of homeostasis in the professional and personal realm among expert emergency medicine physicians. Among healthy emergency physicians, diet, sleep, and exercise patterns intertwined with perspectives, habits, personal philosophies, and social activities contributed to maintenance of wellness.
Introduction: The diagnostic process is wrought with potential sources of error. Psychologists seek to coach physicians to refine their cognition. Researchers try to create cognitive scaffolds to guide decision-making. Physicians however, are caught in middle between their own daily cognitive processes and these external theories that might influence their behaviour. Few attempts have been made to understand how experienced clinicians integrate guidelines or clinical decision rules (CDRs) into their decision-making. We sought to explore experienced clinicians decision-making via a simulated exercise, to develop a model of how physicians integrate CDRs into their diagnostic thinking. Methods: From July 2015-March 2016, 16 practicing emergency physicians (EPs) were interviewed via a think aloud protocol study. Six cases were constructed and video recorded as prompts to spur the clinicians to think aloud and describe their approach to the cases. Cases were designed to be slightly suggestive for pulmonary embolism or deep vein thrombosis, since these conditions are associated with CDRs. Using a constructivist grounded theory analysis, three investigators independently reviewed the transcripts from the interviews, meeting regularly to discuss emergent themes and subthemes until sufficiency was reached. Disagreements about themes were resolved by discussion and consensus. Results: Our analysis suggests that physicians engage in an iterative process when they are faced with undifferentiated chest pain and leg pain cases. After generating an original differential diagnosis, EPs engage in an iterative diagnostic process. They flip between hypothesis-driven data collection (e.g. history, physical exam, tests) and analysis of this data, and use this process to weigh probabilities of various diagnoses. EPs only apply CDRs once they are sufficiently suspicious of a diagnosis requiring guidance from a CDR and when they experience diagnostic uncertainty or wish to bolster their decision with evidence. Conclusion: EP cognition around diagnosis is a dynamic and iterative process, and may only peripherally integrate relevant CDRs if a threshold level of suspicion is met. Our findings may be useful for improving knowledge translation of CDRs and prevent diagnostic error.
Introduction: High fidelity in-situ simulation has been found to detect system deficiencies, equipment failures, and conditions predisposing to medical errors, also known as latent safety threats (LST). What is not well reported is whether these LSTs are effectively managed. As a part of an ongoing quality improvement project, multidisciplinary, in-situ simulations were conducted across emergency departments (ED) in the Edmonton zone with the aim to identify LST and subsequently manage them to improve patient care. Methods: In 2017 simulations were conducted at EDs in the Edmonton Zone (N=10). Following each simulation, a cross sectional, survey based assessment tool, was completed by participants to identify LST. These LST were shared with the site clinical nurse educator and/or site manager and a management plan made. Two to six months follow-up was made to track progress. For reporting, LST were grouped into themes, progress on LST were coded as either resolved, ongoing, or not managed. Results: A total of 112 LST were identified through 18 separate simulations. The most commonly identified LTS were: resuscitation resource required (n 23), lack of staff training (21), equipment not immediately available (20), IT resource required (8), medication not immediately available (6), staff requiring familiarization (5), medication resource required (5), IT issue (4), large equipment needed (4), small equipment needed (4), lack of staff resource (3), medication needed, (3), equipment malfunction (2), Environment cluttered (2), non-appropriate resource removed (2). Site follow-up identified a total of 52 LST that where resolved, and 60 LST that had ongoing work to manage them. No occurrences of LST not being managed were identified. Conclusion: Simulation was used to effectively identify LST. Creating a structured plan and follow up allowed many LST to be resolved and effectively managed. In 2018 simulation will reassess if LST remain.
Introduction: Despite revolutionary changes in the medical education landscape, journal club (JC) continues to be a ubiquitous pedagogical tool and is a primary way that residency programs review new evidence and teach evidence-based medicine. JC is a community of practice among physicians, which may help translate research findings into practice. Program representatives state that JC should have a goal of translating novel research into changes in clinical care, but there has been minimal evaluation of the success of JC in achieving this goal. Specifically, emergency medicine resident perspectives on the utility of JC remain unknown. Methods: We designed a multi-centre qualitative study for three distinct academic environments at the University of British Columbia (Vancouver, Victoria and Kelowna). Pilot testing was performed to generate preliminary themes and to finalize the interview script. An exploratory, semi-structured focus group was performed, followed by multiple one-on-one interviews using snowball sampling. Iterative thematic analysis directed data collection until thematic sufficiency was achieved. Analysis was conducted using a constructivist Grounded Theory method with communities of practice as a theoretical lens. Themes were compared to the existing literature to corroborate or challenge existing educational theory. Results: Pilot testing has revealed the following primary themes: (1) Only select residents are able to increase their participation in JC over the course of residency and navigate the transition from peripheral participant to core member; (2) These residents use their increased clinical experience to perceive relevance in JC topics, and; (3) Residents who remain peripheral participants identify a lack time to prepare for journal club and a lack of staff physician attendance as barriers to resident engagement. We will further develop these themes during the focus group and interview phases of our study. Conclusion: JC is a potentially valuable educational resource for residents. JC works as a community of practice only for a select group of residents, and many remain peripheral participants for the duration of their residency. Incorporation of Free Open-Access Medical Education resources may also decrease preparation time for residents and staff physicians and increase buy-in. To augment clinical impact, the JC community of practice may need to expand beyond emergency medicine and include other specialties.
Introduction: Free Open Access Medical education (FOAM) resources have been developed using various needs assessment methods. We describe a storytelling exercise used to identify unperceived medical expert learning needs, which also resulted in the emergence of unknown learning needs within intrinsic physician roles. Methods: A FOAM curriculum was created for thrombosis based on an online needs assessment comprised of a topic listing, case scenarios, and a storytelling exercise. In the storytelling exercise, learners described i) a difficult case in thrombosis, and ii) why that case was difficult. In this qualitative description study, we performed a secondary thematic analysis of this storytelling data, coded for CanMEDS 2015 intrinsic roles. Two investigators independently coded transcripts to iteratively generate a coding framework. Results: 143 respondents completed the storytelling exercise. All responses yielded a gap in medical expertise, while 25 (17.5%) described an additional intrinsic theme. Learning needs in all six intrinsic roles were identified. The most commonly cited learning needs were in the Leader (recognizing how resource allocation impacts healthcare), Communicator (communicating expert knowledge with patients), and Collaborator (unclear communication between providers) domains. Participants who described an intrinsic learning need were primarily from emergency medicine (21/25, 84.0%). These excerpts were notable for how they expressed the complexity and affective components of medicine. Conclusion: Storytelling exercises can highlight context, attitudes, and relationships which provide depth to needs assessments. These narratives are a novel method of capturing emergent learning needs, which may be unknown to learner and faculty (Johari window). These intrinsic learning needs may ultimately be used to enrich learner-centered curricula.
Introduction: Cognitive processing theories postulate that decision making depends on both fast and slow thinking. Experienced physicians (EPs) make diagnoses quickly and with less effort by using fast, intuitive thinking, whereas inexperienced medical students rely on slow, analytical thinking. This study used a cognitive task analysis to examine EPs cognitive processes and ability to provide knowledge translation to learners. Methods: A novel mind mapping approach was used to examine how EPs translate their clinical reasoning to learners, when evaluating a patient for a possible venous thromboembolism (VTE). Nine EPs were interviewed and shown two different videos of a medical student patient interview (randomized from six possible videos). Results: EPs were asked to demonstrate their clinical approach to the scenario using a mind map, assuming they were teaching a learner in the Emergency Department. EPs were later re-interviewed to examine response stability, and given the opportunity to make clarifying or substantive mind map modifications. Maps were broken into component pieces and analyzed using mixed-methods techniques. A mean of 15.7 component pieces were identified within each mind map (standard deviation (SD) 7.8). Maps were qualitatively coded, with a mean of 2.8 clarifying amendments (e.g. adding a time course caveat) (SD 1.5-5.75) and 4.4 substantive modifications (e.g. changing the flow of the map) (SD 2-5). Conclusion: Resulting mind maps displayed significant heterogeneity in teaching points and the degree to which EPs used slow thinking. EPs frequently made fast thinking jumps, although learners could prompt slow thinking by questioning unclear points. This is particularly important as learners engage in cognitive apprenticeship throughout their training. An improved understanding of EPs cognitive processes through mind mapping will allow learners to improve their own clinical reasoning (Merrit et al., 2017). Educating EPs on these processes will allow modification of their teaching styles to better suit learners.
Introduction: Fine art education increases the quality and quantity of observations that medical students make in both art and clinical reports. However, there are few free and accessible resources that teach art and observational skills to healthcare learners and providers. CanadiEM.org, a medical education blog, developed a new series called Spot the Diagnosis! to address this gap. The goals of the Spot the Diagnosis! series are to: 1) use art to explain medical concepts, 2) tie medical concepts to visual art, 3) hone observational skills, and 4) expose healthcare providers to art. Methods: Each piece of art for the Spot the Diagnosis! Series is selected based upon the author’s art history knowledge, resources found using an online search, and/or suggestions made by other healthcare professionals. The accompanying blog post is researched and written by a medical student in a question-and-answer style and peer-reviewed by another medical student and physician. Posts are uploaded monthly to CanadiEM.org and accessible to anyone with an internet connection. Promotion occurs on site, via email, word-of-mouth, and social media. Viewership is tracked using Google Analytics (GA). A survey for readers is planned to assess who, how, and why readers use the series, but results were not available prior to abstract submission. Results: Six Spot the Diagnosis! posts have been published, each of which begins with the selection of a piece of fine arts that showcases a potential medical diagnosis and a blog post outlining an interpretation of the work informed by observations, historical reports, and medical evidence. Each was published as a blog post on a Saturday and added to a page containing a list of all posts in the broader Arts PRN section on CanadiEM. All contained a single piece of art as the focus, 6 ± 2 (median ± IQR) questions, 638 ± 250 words, and 6 ± 3 references. The answers to questions are hidden under drop-down formatting to allow viewers to arrive at their own answers first. In the first 30 days of publication, each post in the series was viewed 1582 ± 401 times. Conclusion: The Spot the Diagnosis! series is an online educational resource published on CanadiEM.org that aims to improve learners medical knowledge and observational skills by featuring fine arts pieces with relevant question-and-answer style posts. This series fills the gap between art and medicine and has been well received by CanadiEM viewers. We look forward to analyzing responses in our survey to further understand how, why, and who uses this new and innovative resource.